有氧运动康复对冠状动脉慢性闭塞患者PCI术后心肺功能的影响

Effects of aerobic exercise rehabilitation on cardiopulmonary function in patients after percutaneous coronary intervention for chronic total occlusion

目的探讨有氧运动康复对冠状动脉慢性闭塞(CTO)患者经皮冠脉介入治疗(PCI)术后心肺功能的影响。方法选择2019年1月至2021年12月于十堰市太和医院心血管诊疗中心连续纳入经冠状动脉(冠脉)造影明确诊断为CTO并成功行PCI的患者43例,随机分为常规组(n=22)和运动康复组(n=21)。常规组予以冠状动脉粥样硬化性心脏病(冠心病)规范药物治疗、健康教育;运动康复组在常规组治疗基础上予以固定踏车运动训练,无氧阈强度,30~40 min/次,5~7次/周。两组分别于术后1周、6月时行心肺运动试验,比较最大摄氧量(VO_(2)max)、最大公斤摄氧量(VO_(2)max/kg)、代谢当量(METs)、二氧化碳通气当量斜率(VE/VCO_(2)slope)、分钟自主通气量(VE)、做功效率(VO_(2)/WR)、氧脉(VO_(2)/HR)、峰值心率(HRPeak)和无氧阈时公斤摄氧量(AT)的变化情况。结果两组受试者基线时VO_(2)max、VO_(2)max/kg、METs、VE/VCO_(2)slope、VE、VO_(2)/WR、VO_(2)/HR、HRpeak和AT差异均无统计学意义(P>0.05);与基线时比较,常规组上述指标在6月时无明显变化(P>0.05),而运动康复组在6月时VO_(2)max、VO_(2)max/kg、METs、VE、VO_(2)/WR、VO_(2)/HR、HRpeak和AT较基线均有显著改善(P<0.05)。两组受试者组间比较,运动干预后运动康复组VO_(2)max、VO_(2)max/kg、METs、VE、VO_(2)/WR、VO_(2)/HR和AT较常规组均显著改善(P<0.05),而VE/VCO_(2)slope和HRpeak无明显变化(P>0.05)。结论有氧运动训练可有效改善CTO患者PCI术后的心肺功能,是CTO患者PCI术后的一种安全、有效的心脏康复方案。

Objective To explore the effect of aerobic exercise rehabilitation on cardiopulmonary function in patients with Chronic Total Occlusion(CTO)following Percutaneous Coronary Intervention(PCI).Methods From January 2019 to December 2021,43 patients diagnosed with CTO and successfully treated with PCI at the Cardiovascular Diagnosis and Treatment Center of Taihe Hospital in Shiyan City were enrolled.They were randomly divided into the routine group(n=22)and the exercise rehabilitation group(n=21).The routine group received standardized drug treatment for coronary heart disease and health education,while the exercise rehabilitation group underwent fixed bicycle exercise training based on the routine group at an anaerobic threshold intensity for 30~40 minutes/session,5~7 sessions/week.Cardiopulmonary exercise tests were performed at one week and six months postsurgery,and the changes in maximum oxygen uptake(VO_(2)max),maximum oxygen uptake per kilogram(VO_(2)max/kg),metabolic equivalent(METs),carbon dioxide ventilation equivalent slope(VE/VCO_(2)slope),minute ventilation(VE),work efficiency(VO_(2)/WR),oxygen pulse(VO_(2)/HR),peak heart rate(HRPeak),and oxygen uptake per kilogram at the anaerobic threshold(AT)were compared.Results At baseline,there were no significant differences in VO_(2)max,VO_(2)max/kg,METs,VE/VCO_(2)slope,VE,VO_(2)/WR,VO_(2)/HR,HRpeak,and AT between the two groups of subjects(P>0.05).Compared with baseline,there were no significant changes in these indicators in the standard care group at 6 months post-treatment(P>0.05).However,in the exercise rehabilitation group,VO_(2)max,VO_(2)max/kg,METs,VE,VO_(2)/WR,VO_(2)/HR,HRpeak,and AT showed significant improvement at 6 months post-treatment compared to baseline(P<0.05).When comparing between the two groups of subjects,after exercise intervention,VO_(2)max,VO_(2)max/kg,METs,VE,VO_(2)/WR,VO_(2)/HR,and AT in the exercise rehabilitation group were significantly improved compared to the standard care group(P<0.05),while there were no significant changes in VE/VCO_(2)slope and HRpeak(P<0.05).Conclusion Aerobic exercise training can effectively improve cardiopulmonary function in CTO patients after PCI,and it is a safe and effective cardiac rehabilitation program for CTO patients after PCI.